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Bukasa LL, Namiba A, Brown M, Ndu'ngu E, Nangwale M, Letting G, Chirwa P, Thorne C, Tariq S. Setting the research agenda: involving parents in research on children who are HIV-free. J Int AIDS Soc 2023; 26 Suppl 4:e26150. [PMID: 37909217 PMCID: PMC10618900 DOI: 10.1002/jia2.26150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/14/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION There is growing interest in health, developmental and survival outcomes of children who are born HIV-free to women living with HIV (children born HIV-free). To date, the research agenda has been largely determined by researchers, funders and policy makers, with limited involvement of parents, who are key stakeholders. Researchers at UCL Great Ormond Street Institute of Child Health in partnership with community-based organisation 4M Network of Mentor Mothers conducted two workshops with parents in March 2022 to establish research priorities for children born HIV-free, and key considerations for methodological approaches both to research and engagement with the affected communities. DISCUSSION When exploring research on children born HIV-free, we consider the following: what aspects of current research are aligned with women and parents' priorities, what is missing and what approaches would be preferred. A holistic approach to research on children born HIV-free should be prioritised, focussing on a breadth of outcomes and how they intersect. Secondary use of existing data sources should be maximised to facilitate this, with a view of monitoring the long-term effects of fetal antiretroviral drug exposure alongside other key health and developmental outcomes. Involving and engaging with parents, and children where possible, must be at the heart of research design to maximise relevance and impact of findings for the affected communities. Potential barriers to engaging with individuals who were children born HIV-free include parental disclosure and individuals not identifying as a child born HIV-free to a mother living with HIV. Stigma-free language must be incorporated into the vocabulary of researchers and other stakeholders, avoiding reference to exposure; we propose the term "children born HIV-free." CONCLUSIONS Mothers and parents living with HIV should be involved in research about their children born HIV-free and are key in identifying research priorities so that findings may translate into an impact on their children's health and wellbeing. Meaningful involvement of women living with HIV through trusted community partners is an effective mechanism by which to elicit views on research about their children.
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Affiliation(s)
| | | | | | | | | | | | | | - Claire Thorne
- UCL Great Ormond Institute of Child Health, London, UK
| | - Shema Tariq
- UCL Institute for Global Health, London, UK
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
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Davtyan M, Kacanek D, Lee J, Berman C, Chadwick EG, Smith R, Salomon L, Frederick T. The role of internalised HIV stigma in disclosure of maternal HIV serostatus to children perinatally HIV-exposed but uninfected: a prospective study in the United States. J Int AIDS Soc 2023; 26 Suppl 4:e26167. [PMID: 37909234 PMCID: PMC10618870 DOI: 10.1002/jia2.26167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/23/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Decisions to disclose HIV serostatus may be complicated by internalised HIV stigma. We evaluated the association of internalised HIV stigma in biological mothers living with HIV with disclosure of their serostatus to their children perinatally HIV-exposed but uninfected (CHEU). METHODS Mothers and their CHEU were enrolled in the United States (U.S.)-based Surveillance Monitoring for Antiretroviral Therapy (ART) Toxicities (SMARTT) study of the Pediatric HIV/AIDS Cohort Study (PHACS), a longitudinal study of outcomes related to in utero exposure to HIV and ART among CHEU. Mothers completing at least one stigma and disclosure assessment starting at the child's age 11-, 13-, 15- and/or 17-year study visits between 16 August 2016 and 1 October 2020 were eligible. Stigma was measured with the 28-item Internalised HIV Stigma Scale (IHSS). Mean stigma scores were linearly transformed to a range of 0-100, with higher scores indicating greater levels of stigma. At each visit, mothers were asked if their child was aware of their HIV diagnosis and at what age the child became aware. The Kaplan-Meier estimator evaluated the cumulative probability of disclosure at each child age. Logistic regression models with generalised estimating equations to account for repeated measures were fit to examine the association between stigma and disclosure, controlling for relevant socio-demographic variables. RESULTS Included were 438 mothers of 576 children (mean age 41.5 years, 60% U.S.-born, 60% Black/African American and 37% with household income ≤$10,000). The prevalence of disclosure across all visits was 29%. Mothers whose children were aware versus not aware of their serostatus reported lower mean IHSS scores (38.2 vs. 45.6, respectively). The cumulative proportion of disclosure by age 11 was 18.4% (95% CI: 15.5%, 21.8%) and 41% by age 17 (95% CI: 35.2%, 47.4%). At all child ages, disclosure was higher among children of U.S.-born versus non-U.S.-born mothers. After adjusting for age, marital status and years since HIV diagnosis, higher IHSS scores were associated with lower odds of disclosure (OR = 0.985, 95% CI: 0.975, 0.995). CONCLUSIONS Providing support to women as they make decisions about serostatus disclosure to their children may entail addressing internalised HIV stigma and consideration of community-level factors, particularly for non-U.S.-born mothers.
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Affiliation(s)
- Mariam Davtyan
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Deborah Kacanek
- Harvard T.H. Chan School of Public HealthCenter for Biostatistics in AIDS ResearchBostonMassachusettsUSA
| | - Jessica Lee
- Harvard T.H. Chan School of Public HealthCenter for Biostatistics in AIDS ResearchBostonMassachusettsUSA
| | - Claire Berman
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Ellen G. Chadwick
- Department of PediatricsFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Renee Smith
- Department of PediatricsCollege of MedicineUniversity of IllinoisChicagoIllinoisUSA
| | - Liz Salomon
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Toinette Frederick
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Adella GA, Yimer MA, Abebe EC. Human immunodeficiency virus positive status disclosure among children in northwest Ethiopia: a cross-sectional study. Afr Health Sci 2023; 23:178-189. [PMID: 37545911 PMCID: PMC10398430 DOI: 10.4314/ahs.v23i1.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Background Human Immunodeficiency Virus positive status disclosure is an essential component of pediatric care and longterm disease management. However, one of the greatest challenges that caregiver/mothers and health care workers face is the disclosure of HIV positive status to children living with the virus. Therefore, the objective of this study was to assess HIV positive status disclosure and associated factors among HIV positive children in northwest Ethiopia. Methods Institutional based cross-sectional study was conducted among 417 sampled HIV positive children attending pediatric ART clinics of public health facilities from February 01 to March 30 2020 in northwest Ethiopia. Simple random sampling technique was used to select study participants. A structured interviewer administered questionnaire was used for data collection and the collected data entered into Epi data software. Binary logistic regression analysis was done and variables with P-value <0.05 was considered as a significant predictors of HIV positive status disclosure of HIV positive children. Result From 417 sampled population, 390 were involved in this study making 93.5% response rate. The study revealed that 53.6% with 95% CI (0.486-0.586) of HIV positive children knew their HIV positive sero status. Caregiver/mothers who had greater than three family sizes (AOR=1.984, 95% CI=1.046-3.762), children whose ages greater than 10 years (AOR=6.679, 95% CI=3.372-13.227) and children on ART for more than 5 years (AOR=8.96, 95% CI=6.402-12.257) were predictors of HIV positive status disclosure. Conclusion The HIV positive status disclosure was high in the study area relative to other studies. Family size, children age, and length of children on ART were predictors of HIV positive status disclosure for HIV positive children. Health care providers, especially those working at pediatrics ART clinics should keep these factors in mid while working with caregivers to encourage disclosure of HIV positive status.
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Affiliation(s)
- Getachew Asmare Adella
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia, Ethiopia
| | - Meklit Abie Yimer
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Reproductive Health and Nutrition Department, School of Public Health College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Lightfoot M, Campbell R, Khumalo-Sakutukwa G, Chingono A, Hughes S, Taylor K. Motivators and Barriers for Parents to Disclose their HIV Status to Children. VULNERABLE CHILDREN AND YOUTH STUDIES 2022; 18:231-241. [PMID: 36970707 PMCID: PMC10035580 DOI: 10.1080/17450128.2022.2131948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 09/20/2022] [Indexed: 06/18/2023]
Abstract
Disclosure to children has been identified as one of the main challenges for parents living with HIV (PLH). The aim of this study was to qualitatively explore motivators, barriers, and the process of parental disclosure in a Zimbabwean community with high HIV prevalence. A total of 28 PLH participated in three focus groups comprising PLH who had disclosed their HIV status to their children (n = 11), PLH who had not disclosed to their children (n = 7), and the third group contained PLH who both had and had not disclosed their status (n = 10). Full, partial and indirect disclosure approaches were used by parents. Barriers to disclosing included the children being "too young" and lacking understanding of HIV as well as inability to maintain confidentiality around parents' status, 2) causing the child to worry, 3) being embarrassed, and 4) fearing that disclosure would prompt a child to treat a parent with disrespect. Motivators included 1) support of various kinds from their children, 2) educating their children around HIV risk, and 3) facilitating discussions about parental illness and death. Our findings suggest that understanding the barriers to disclosure is likely insufficient for supporting and promoting parental disclosure. The motivation for disclosure, support for the disclosure process, and culturally relevant interventions are needed to promote and support parental disclosure.
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Affiliation(s)
- Marguerita Lightfoot
- Division of Prevention Science, University of California, San Francisco, San Francisco, USA
| | - Renisha Campbell
- Division of Prevention Science, University of California, San Francisco, San Francisco, USA
| | | | - Alfred Chingono
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Shana Hughes
- Division of Prevention Science, University of California, San Francisco, San Francisco, USA
| | - Kelly Taylor
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, USA
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Atugba TA, Aninagyei E, Binka FN, Duedu KO. Factors Influencing HIV Status Disclosure to Partners Among Antiretroviral Therapy Clients in the Upper East Region, Ghana. AIDS Behav 2022; 26:2653-2663. [PMID: 35122579 DOI: 10.1007/s10461-022-03612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/01/2022]
Abstract
In Ghana, HIV status disclosure to partners is voluntary. This study sought to determine the factors associated with HIV status disclosure to partners among antiretroviral therapy (ART) clients in the Upper East Region. A matched case-control study (1:1) was carried out in nine ART sites in the Upper East region in which 100 ART sexually active clients who had not disclosed their status to their partners were compared with 100 ART sexually ART clients who had disclosed their status to their partners. To each of the 200 study participants, a structured questionnaire was administered to elicit relevant responses. Discordant pair analysis was done with Mantel-Haenszel matched test to determine associations between variables. The study found persons with informal education more likely to disclose HIV status, whereas persons living apart or not having children with a partner were less likely to disclose their status to their sexual partners. On the other hand, active involvement or participation in ART-related services were more likely going to impact HIV status disclosure. Early initiation of ART, while adherence to ART services and the use of treatment monitors were less associated with disclosure. Active participation in ART related services such as prompt initiation of ART following diagnosis, adherence promotion, and treatment monitoring should be encouraged to promote HIV status disclosure among sexual partners.
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Yami DB, Tuji TS, Gelete BW, Beyene Workie K. Disclosure status of HIV-positive children and associated factors among children in public health facilities in East Arsi zone, Oromia regional state, South Eastern Ethiopia: A cross-sectional study. SAGE Open Med 2022; 10:20503121211068725. [PMID: 35024145 PMCID: PMC8744189 DOI: 10.1177/20503121211068725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/05/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: This study aims to assess the disclosure status of HIV-positive children and
its associated factors in selected hospitals in East Arsi zone, Oromia
regional state, Ethiopia, 2020. Methods: Institutional-based cross-sectional study design was conducted on 410 sample
size. Four hospitals were randomly selected among hospitals that currently
gave service. Data were collected from caregivers/biological parents by
interviewing from 30 July 2020 to 30 August 2020 using the systematic random
sampling technique. In logistic regression analysis, the variables which had
independent correlations with dependent variable were identified based on
adjusted odds ratio and a p value <0.05 with 95%
confidence interval was claimed as statistically significant. Results: Disclosure status of HIV-positive children was 59.8%, 95% confidence interval
(54.9, 64.1). Children diagnosed at the age of <5 (adjusted odds ratio =
0.25, 95% confidence interval (0.126, 0.49)), antiretroviral therapy
follow-up for 6–15 years (adjusted odds ratio = 2.08, 95% confidence
interval (1.013, 4.29)), children diagnosed at the appropriate age of ⩾12
years (adjusted odds ratio = 1.95, 95% confidence interval (1.09, 3.49)),
and children diagnosed at the age of <11 years (adjusted odds ratio =
4.5, 95% confidence interval (3.45, 8.38)) were positively associated
factors to disclose status. Conclusion: The disclosure status of HIV-positive children was low in this study.
Antiretroviral therapy follow-up for 6–15 years, children diagnosed at the
appropriate age of ⩾12 years, children diagnosed at the age of <5 years,
and children who aged below 11 years were positively associated with
disclosure status. Thus, we recommended, health care providers and all
stakeholders should give age-appropriate counseling regarding when and why
to disclose their status.
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Affiliation(s)
- Dereje Bikila Yami
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Techane Sisay Tuji
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
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Wariri O, Ajani A, Raymond MP, Iliya A, Lukman O, Okpo E, Isaac E. "What will my child think of me if he hears I gave him HIV?": a sequential, explanatory, mixed-methods approach on the predictors and experience of caregivers on disclosure of HIV status to infected children in Gombe, Northeast Nigeria. BMC Public Health 2020; 20:373. [PMID: 32197648 PMCID: PMC7085175 DOI: 10.1186/s12889-020-08506-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background With increasing access to effective Anti-Retroviral Therapy (ART), the proportion of children who survive into later childhood with HIV has increased. Consequently, caregivers are constantly being confronted with the dilemma of ‘if’, ‘when’, and ‘how’ to tell their children living with HIV their status. We aimed to determine the prevalence and predictors of disclosure and explore the barriers caregivers face in disclosing HIV status to children living with HIV in Gombe, northeast Nigeria. Methods We conducted a sequential, explanatory, mixed-methods study at the specialist Paediatric HIV clinic of the Federal Teaching Hospital Gombe, northeast Nigeria. The quantitative component was a cross sectional, questionnaire-based study that consecutively recruited 120 eligible primary caregivers of children (6–17 years) living with HIV. The qualitative component adopted an in-depth one-on-one interview approach with 17 primary caregivers. Primary caregivers were purposively selected to include views of those who had made disclosure and those who have not done so to gain an enhanced understanding of the quantitative findings. We examined the predictors of HIV status disclosure to infected children using binary logistic regression. The qualitative data was analysed using a combined deductive and inductive thematic analysis approach. Results The mean age of the index child living with HIV was 12.2 ± 3.2 years. The prevalence of disclosure to children living with HIV was 35.8%. Children living with HIV were 10 times more likely to have been told their status if their caregivers believed that disclosure had benefits [AOR = 9.9 (95% CI = 3.2–15.1)], while HIV-negative compared to HIV-positive caregivers were twice more likely to make disclosures [AOR = 1.8 (95%CI = 0.7–4.9)]. Girls were 1.45 times more likely than boys to have been disclosed their HIV positive status even after adjusting for other variables [AOR = 1.45 (95% CI = 0.6–3.5)]. Caregivers expressed deep-seated feeling of guilt and self-blame, HIV-related stigma, cultural sensitivity around HIV, and fears that the child might not cope as barriers to non-disclosure. These feeling were more prominent among HIV-positive caregivers. Conclusion The process of disclosure is a complex one and caregivers of HIV positive children should be supported emotionally and psychologically to facilitate disclosure of HIV status to their children. This study further emphasises the need to address HIV-related stigma in resource constrained settings.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, The Gambia. .,Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK.
| | - Ayomikun Ajani
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria
| | | | - Asabe Iliya
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria
| | - Olatoke Lukman
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria
| | - Emmanuel Okpo
- Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK.,Department of Public Health Medicine, NHS Grampian, Aberdeen, UK
| | - Elon Isaac
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria.,Department of Paediatrics, College of Medical Sciences, Gombe State University, Gombe, Nigeria
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Appiah SCY, Adekunle AO, Oladokun A, Dapaah JM, Nicholas KM. Parental Disclosure of Own HIV Status to Children in Two Ghanaian Regions; Examining the Determinants within a Child Vulnerability Context. Health (London) 2019. [DOI: 10.4236/health.2019.1110104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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